注意缺陷多動障礙患者的早逝風險

People with a diagnosis of attention deficit disorder are at higher risk of dying young than those without the disorder, usually in automobile crashes and other accidents, suggests research reported on Wednesday, from the largest study of A.D.H.D. and mortality to date.

週三，《柳葉刀》雜誌(The Lancet)上發表了迄今關於A.D.H.D.（attention deficit hyperactivity disorder，注意缺陷多動障礙）與死亡率的規模最大的研究，該研究報告：與無注意缺陷障礙者相比，確診此疾病的患者的早逝風險較大，他們常在交通事故或其他意外中喪生。

The study, an analysis of nearly two million Danish Medical records, found that the odds that any individual with attention deficit hyperactivity disorder died young were still very low, about three in 1,000. But those with the disorder often had companion problems — drug abuse, for example, or antisocial behavior — that increased those odds.

研究分析了近200萬名丹麥人的病歷，然後發現：注意缺陷多動障礙患者的早逝機率依舊很低，約爲千分之三。但該疾病的患者往往併發有其他問題，例如藥物濫用、反社會行爲等，這些都會增加他們的早逝機率。

Previous research had provided reason to suspect a link between attention deficits and mortality. But the new paper gives a clearer picture of the risks, and the possible reasons behind them, experts said. The study was published in The Lancet.

既往已有研究懷疑注意缺陷與死亡率之間存在關聯，並提出了一些理由。然而，專家指出，這篇新論文對死亡風險及其背後可能的原因都做出了更清楚的闡述。

Stephen Faraone, a professor of psychiatry at SUNY Upstate Medical University in Syracuse, said the findings should not panic parents of children with attention problems. “But this is a large, well-done study, and I see it as a red flag planted in the terrain, a reason to identify and treat A.D.H.D.” earlier rather later, said Dr. Faraone, who was not involved in the research.

美國紐約州立大學上州醫科大學（SUNY Upstate Medical University，位於錫拉丘茲市，又譯雪城）的精神病學教授史蒂芬·法勞內(Stephen Faraone)表示，存在注意問題的患兒的家長無需因該研究結果而感到恐慌。“但是，我認爲，這項大型、高質量的研究爲我們敲響了警鐘，併爲及早識別並治療A.D.H.D.提供了依據，”法勞內博士補充道，他本人並沒有參與這項研究。

In the study, a research team led by Dr. Soren Dalsgaard of Aarhus University analyzed the medical histories of all children born in Denmark between 1981 and 2011. The team found that of 32,061 who had been given a diagnosis of A.D.H.D., 107 had died before age 33. That was roughly twice the rate of premature death among those without the disorder, after factors like age, psychiatric history and employment were taken into account.

在這項研究中，丹麥奧胡斯大學(Aarhus University)的蘇林·達爾斯高(Soren Dalsgaard)博士領導研究團隊分析了在1981年至2011年之間出生於丹麥的所有兒童的病史。他們發現，在32061名確診爲A.D.H.D.的患兒中，有107人在33歲之前死亡。在將年齡、精神病史和就業情況等因素納入考慮後，患者的過早死亡率幾乎是非患者的兩倍。

The risk was even higher in people who received a diagnosis at age 18 or later, the study found — possibly because of the severity of such cases, the authors wrote. They included researchers from the Lundbeck Foundation in Denmark, which funded the research, and the Child Study Center at Yale.

研究發現，在年滿18歲後確診的患者中，上述風險還要更高——這可能是因爲這類病例通常較爲嚴重，作者寫道。研究團隊還包括來自丹麥倫德貝克基金會（Lundbeck Foundation，研究的資助方）和耶魯大學(Yale)兒童研究中心(Child Study Center)的研究人員。

But that heightened risk could also reflect a late diagnosis, Dr. Faraone said. Children with undiagnosed attention deficits often go off track, academically and socially, and by 18 may be living more recklessly than their peers.

法勞內還說：這種高風險也反映出該疾病的診斷往往偏晚。患有注意缺陷卻漏診的兒童在學術和社交領域都更容易脫離正軌，他們在18歲前也很可能比同齡人更加冒失魯莽。

“If you look at the groups of problems that tend to go with A.D.H.D — conduct disorders, antisocial behaviors, substance use,” he said, “only one of these is easily treatable. And that’s A.D.H.D.”

“看看這些經常伴隨A.D.H.D.出現的問題吧：品行障礙、反社會行爲、物質使用障礙，”他說，“其中唯一容易治療的就是A.D.H.D.。”